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Prevalence of and Factors Associated With Subclinical Posttraumatic Stress Symptoms and PTSD in Urban and Rural Areas of Montana: A Cross-Sectional Study

Authors

  • Lance D. Erickson PhD,

    Corresponding author
    • Department of Sociology, Brigham Young University, Provo, Utah
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  • Dawson W. Hedges MD,

    1. Department of Psychology, Brigham Young University, Provo, Utah; The Neuroscience Center, Brigham Young University, Provo, Utah
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  • Vaughn R. A. Call PhD,

    1. Department of Sociology, Brigham Young University, Provo, Utah
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  • Byron Bair MD

    1. Director, Veterans Rural Health Resource Center – Western Region, Department of Veterans Affairs Office of Rural Health, Salt Lake City, Utah; Professor, Geriatric Internal Medicine and Geriatric Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
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  • Funding: This research was supported by the Veterans Administration (VA) Office of Rural Health.

  • Disclosures: The VA reviewed this manuscript prior to submission to The Journal of Rural Health. The views expressed herein do not necessarily represent the views of the VA or the US government. Drs. Erickson and Call had full access to all the data in the study and take responsibility for the integrity of the data.

For further information, contact: Lance Erickson, PhD, 2030 JFSB, Department of Sociology, Brigham Young University, Provo, UT 84602; e-mail: lance_erickson@byu.edu.

Abstract

Purpose

Posttraumatic stress disorder (PTSD) is an important clinical problem, but little is known about PTSD in rural, nonclinical populations. To better understand PTSD in rural areas, we examined the prevalence and risk and protective factors in urban, rural, and highly rural communities in Montana for both subclinical posttraumatic stress symptoms (PTSS) and PTSD.

Methods

We compared the prevalence of PTSS and PTSD in urban, rural, and highly rural communities in bivariate and multivariable regression analyses using self-reported cross-sectional survey data from the Montana Health Matters study (N = 3,512), a state-representative household-based survey done in 2010-2011. We also explore potential risk and protective factors for PTSS and PTSD and whether risk and protective factors for each differ by rurality.

Findings

There were no differences in the level of PTSS by rurality in bivariate or multivariate models, and the bivariate relationship between rurality and PTSD became nonsignificant in a multivariate model. Only locus of control was predictive for PTSS; however, gender, age, marital status, income, employment status, community fit, locus of control, and religiosity were associated with PTSD. Some risk and protective factors operate differently by rurality.

Conclusions

Although our findings are subject to weaknesses common to cross-sectional data and are based on questionnaire reports, it appears that there are different risk and protective factors for PTSS and PTSD, suggesting that PTSD may be qualitatively different from PTSS. Furthermore, differences in risk and protective factors across urban and rural communities suggest more attention is needed to understand PTSD in rural communities.

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